Packaged surgical sutures and method of preparing same



March 13, 1956 w. o. ELSON PACKAGED SURGICAL SUTURES AND METHOD OF PREPARING SAME 5 Sheets-Sheet 1 Filed April 24. 1952 WWE IN V EN TOR.

50 QMGEE wexo wzmizkw 024 nmNjsmtw FBI 6 (SEW zoramomm m t mzou B? ATTORNEV March 13, 1956 V w. o. ELSON PACKAGED SURGICAL SUTURES AND METHOD OF PREPARING SAME Filed April 24, 1952 Fly. 3

v 5 Sheets-Sheet 2 STERILIZATON TIME IN DAYS AT ROOM TEMPERATURE SHRINKAGE TEMPERATURE CHANGE OF PLAIN *I GUT WlTI-I TIME AND VOLUME PERCENT ETHYLENE OXIDE up CONTROL Ixeo E 0.5 E LOZ n. -30% F- LLL i o z E I .0 95

WEEKS OF AGIING;

IN V EN TOR.

' ATToR/vEH March 13, 1956 w. o. ELSON 2,738,059

PACKAGED SURGICAL SUTURES AND METHOD OF PREPARING SAME Filed April 24. 1952 5 Sheets-Sheet s SHRINKAGE TEMPERATURE QHANQE OF CHROMICM GUT wTTH TIME AND VOLUME PERCENT ETHYLENE OXIDE CON 3:, 8o TROL 3 r- 0.52 I 0% w T E 2.0 -.s.oz eo Ld 5 26 Z |o oZ K! 40 l l I WEEKS OF Aql N G TEMPERATURE ABSORBENCV DECREMENT RELATlON TO PLAIN GUT WEIGHT AND ETHYLENE OXIDE CONCENTRATION A mo ma TEMPERATURE 2 ABSORBENCY REMENT I I SIZE #0 Lu 3 0.2 T. :2 U

VOLUME PERCENT ETHYLENE OXlDE (2/ INVgNZR. w

nrroRA/EV March 13, 1956 w. o. ELSON 2,738,059

PACKAGED SURGICAL SUTURES AND METHOD OF PREPARING SAME Filed April 24, 1952 5 Sheets-Sheet 4 TEMPERATURE 9 ABSORBE'NCV g DECREMENT I CONTROL DIGESTION TIME IN HOURS TEMPERATURE ABSORBENCV DECREMENT RELATION TO CHROMIC cur WEIGHT AND ETHYENE CONCENTRATION \N qRAMs A3 A5 A7AIOAI3 TEMPERATURE ABSORBENCY DECREMENT I 3 ul 3 F a 3 SIZE *000 VOLUME PERCENT ETHYLENE OXIDE IN 1 'EN TOR.

0 1 1 2-6 mm 6%- 9121/ BY ATTORNEV March 13, 1956 W. O. ELSON PACKAGED SURGICAL SUTURES AND METHOD OF PREPARING SAME Filed April 24, 1952 ENZYME 5 Sheets-Sheet 5 DIGESTION RESIDUE WEIGHT METHOD TEMPERATURE ABsoRBEN Y O DECREMENT CONTROL Auo \OO I l i [7!QESTION TIME HOURS JNVENTOR Z1116; 8 BY ATTORNEV PKCKAGED SURGICAL. FUTURES AND METH D William; 0. Elson,v Wheaten; IIL, assignorto: The Kendallm nrs. st m s, a: c r of M s ash S sa Application April 24,1952, Serial No. 284,174

11 Claims. (Cl ..20663. 3)

'l hisinvention relates to proteinaceous sutures generally referred to a. catgut sutures and more particularly tothe: preparation of such. sutures for surgical use- Sale of surgicah catgut in the United States is subject. to. i

the rigid specifications set upby the U. S; Pharmacopoeia and. enforced by Government. agencies. These. specificatioIlS include, besides imperative sterility, standards of straight pull strength, knot strength: andgauge;

Present day commercial methods of catgut preparation: for: surgical. use universally involve heat-sterilization. Heat+sterili zatiorr techniques can be successfiully carried out to' produce. surgical sutures conforming with the U. S- Pharmacopoeia strength requirements, provided the heat: sterilization. takes place in the absence of all but minute quantities of water. The minimum amount of watenpen missible at the time of heat-sterilization is insufiicient; however, to give the suture that plasticity and flexibility which the surgeon regards as essential for his easy manipulation and knot tying. Hence, additional water must be added beioreuse.

Since. the surgeon prefers that the suture: be flexible.

whenit is, removed from. the tube, most. sutures aren w i merehandised. in. so-called non-hoilable form, thatyis, inv agform wherein the suture contains a greater moisture content. than that which is permissible during heat-sterilization. In. order to merchandise the suture in this form, t is s a y to a Water aft h sats il n.

A t a metho o nufm r s. t erefqre el t sterilize the suture in. substantially dry formin art-tins led tube after suitable mechanical preparation, such aspqlishing, abrading, etc. Thereafter, a tubing fluid containing such. amount. of water as .is necessary to plastioi-zes the all:

ture is added. by aseptic: technique. The. tube: containing the suture and. fluid is, then. sealed. Prior to use, one need merely cleanse the outside of. the tube by immersing the. tube in a. germicidal solution and then break the. tube, andremove and. straighten the suture.

Raw unsterilized catgut, has. repeatedly been shown to be highly resistant tov enzyme. digestion and, henee, it isgenerally recognized that in animal tissue it, would have a. very slow rate. of absorption if indeed it can be considered asbeingabsorba-ble at all.

One of the incidents of heatrsterilization is: a large decrease in: the resistance of the catgut to absorption in living; tissue. Such a decrease is'sometimes decidedly dis advantageous, for, in many instances of surgical use, substantial. catgut resistance to'digestion may be desirable; I know of no practical way of avoiding'substanti'al in absorption resistance of heat-sterilized catgut,

In fact, the resistance of heat-sterilized plain catgut to ICC absorptionfis, so l ow. that. manutacturershave res rted, tor a. ins re e Pr u atis. w ssneralln.

known as chromic. catgut. By such tanning. treatmenh,

a heatasterilized chromic gut may be; prepared, which: has.

a. slower rate. of. absorption in; living. tissue thanthat'ofi, a plain heat-sterilized metal-free or, untanned catgut, However, again, the rate of absorptionof, a sterilized chmmis t u is m reater than ts a t em n.

u d ba t t hs ot been su iec s t ehsa of atiqncharacteristics of a plain catgut over a wide; range; oil a ceptable, absorption.

e ce. n, the case of either lain or chromi a gut. application ot: the heat of sterilization has; two,- draw backs; first, it, lowers resistance to absorption by 4 1: 11;;

avoidable substantial amount so great that practically a l athr i dr a r shtsmic. catgutwhicaissubs. stantially. non-absorbable, or of only slowabsorbahi i yt an -le be P epa ed; an ec nd. he e s f ea e cannot be varied for any individual suture, ehr ornieor plain, over any very wide range. of. cceptable absorption.

Ibis fi t l a Provides, fer flier fir t me. a: meth d for controlling the absorption characteristics ofplainorchr omic. catgut over a wide range of acceptable-absorption. still preparing a sterile suture.v The; control; is; so; precise that I may produce a sterile catgut that has; any

desired. rate of absorption in living tissueallth Wayfironr:

avery; iast. nate,,equal to or faster than. that of. presentday plain'heat-sterilized catgut, up torates; that. are SO $0366..

thatthec suture, in effect, becomes asubstantialjly ngnaap,

sorbable. "suture, i. e., one which has.- as; muchresistance.

. valuable'properties of the raw material which manufacr tur e rsfhave never been. able to provide for surgeons. in; the. finished sterilized product. Such relatively nolkabsorbable U. S. P. sterile catgut sutures are Wholly new.

In addition, lossesin breaking strength during; sterilization. of my. products are much less than those causedrby heat-sterilization. Y

l have found that in a reaction product of catgut with ethylene. oxide. in'very small proportions, as hereinafter. described, the absorption characteristics .in living animal tissue may be varied over a wide range from almost nonahsorption to fast absorption in more or less direct pro.-. portion to the ratio of ethylene oxide to the. catgut, pro.-. vided. that the. catgut is not subjected iniprocessing to any heat above C.

My investigations show that the amount; ofi ethylene oxide, necessary to secure sterility is very minute when the catgut. is stored in a hermetically sealed package in any conventional tubing fluid to which the ethylene oxide has been added.

I have further discovered that the presence. of ethylene oxide in such a package in excess of about 3% by V lume of the tubing fluid will, over a period of storage, have" such. a reactive effect upon small size 60-inch lengthsof catgut, for example No. 0, or smaller, that the'catgut, upon. removal. from the package, will not meet S." P. strength requirements.

Patented Mar. 13., 19.5.6

s he e s o a of co ro n e bso ption While it is possible to maintain U. S. P. strength requirements even after prolonged periods of storage with amounts of ethylene oxide up to 3% by volume of the tubing fluid, I have discovered that as much as 3% of ethylene oxide in all cases of U. S. P. gauge sutures, deprives the catgut of satisfactory absorption rates. Hence, in accordance with this invention, the proportion of ethylene oxide by volume of the tubing fluid is held within a critical range which has, as its minimum, the percentage of ethylene oxide required for sterility and, as a maximum, the percentage of ethylene oxide which does not increase the rate of absorption beyond practical surgical acceptability. Expressed in terms of volume tubing solution, this range is, for reasons hereinafter shown to be critical, from .01 to 2% by volume in the case of 3 /2 cc. of tubing fluid depending directly upon the weight of the catgut and the desired rate of absorption.

Marked additional advantages are gained by the use of ethylene oxide as the sterilizing agent. First, it may readily be added to the conventional tubing fluids; second, the packaging of the product may be carried out without aseptic techniques-sterility is achieved wholly by storage atroom temperature in sealed tubes; and, third, water or other catgut softening agent in sufficient quantity to maintain the catgut flexible may be included at the time of sealing without causing any detrimental effect, such as occur, as previously outlined, if such quantities of water are present during heat-sterilization. A very easily packaged product with substantial manufacturing savings is thus provided. Danger of contamination during packaging is wholly eliminated because the packaging does not need to be done aseptically.

Objects of this invention thus include the preparation of hermetically sealed packages of U. S. P. standard plain catgut sutures which may have absorption characteristics in ranges of absorption resistance never heretofore available in packaged sterile catgut suture put-ups.

A further object of this invention is the provision of hermetically sealed packages of catgut sutures, plain or chromic, which sutures are rendered sterile automatically during storage in the sealed package and have absorption characteristics determined by a selected amount of ethylene oxide included in the package at the time of sealing, the suture conforming to U. S. P. standards upon removal after storage for the sterility period.

It is also an object of this invention to provide such packaged sutures, the flexibility of which sutures is predeterminedly controlled by the inclusion at the time of sealing and prior to sterilization, of selected amounts of a softening agent for catgut, inclusive of amounts of water exceeding the permissible heat-sterilization maximum.

Figure 1 is a chart showing the comparative absorption spectra of heat sterilized and ethylene oxide reacted gut.

Figure 2 is a chart showing the time concentration ratio for contaminated No. 4 gut with the concentration expressed as the percent ethylene oxide by liquid volume.

Figure 3 is a chart showing shrinkage temperature of plailnNo. 1 gut with time and volume percent of ethylene on e.

Figure 4 is a chart showing the shrinkage temperature of chromic No. l gut in relation to time and volume percent of ethylene oxide.

Figure 5 is a chart showing the temperature absorbency decrement of plain gut in relation to the weight of the gut and the volume percent of ethylene oxide.

Figure 6 is a chart showing the temperature absorbency decrement of chromic gut in relation to the weight of the gut and the volume percent of ethylene oxide.

Figure 7 is a chart showing the loss in breaking strength in pounds with increasing time of enzyme digestion.

Figure 8 is a chart showing the percent loss in weight with increasing time of enzyme digestion.

Figure 1 illustrates the range of absorption characteristics which I may attain by the practice of my invention, as compared with the highly limited range of absorption sary to accomplish sterilization.

characteristics that are possessed by present-day commercial catgut sutures.

The right hand edge of the absorption spectra of Fig. 1 represents the absorption characteristics of a raw catgut, i. e., one with substantially non-absorbency in living tissue.

The diagram includes zones from left to right representing a zone of very fast absorbability, which is decidedly inferior and not acceptable from the surgeon's standpoint, through fast, moderate, slow and very slow zones.

In the lower portion of the diagram the absorption areas which can be achieved by a plain heat-sterilized gut, are confined to the very fast zone and the faster portion of the fast zone, because heat-sterilization drops the absorption resistance of the gut by such a large amount.

As further shown in the chart of Fig. 1, the absorption rates of heat-sterilized catgut can be extended somewhat to the right, as indicated by the area legended Heat- Chromic, so that the absorption characteristics of chromic guts can be carried through the remainder of the fast absorption zone and into the faster portion of the moderate absorption zone.

The fact that of present-day suture sales are of chromic gut evidences the desire of the surgeon for slower absorption rates. Nevertheless, by no known practical process which is followed by heat-sterilization, can, as the diagram shows, the absorption characteristics be carried into either the slower portion of the moderate zone, the slow or the very slow zones.

In comparison with the limited area of heat-sterilized plain and chromic catgut absorption characteristics, the very wide range of absorption characteristics attained in accordance with this invention by the use of ethylene oxide is also indicated in the diagram of Fig. 1. The absorption characteristics can be carried not only through the moderate zone, but also through the slow zone and almost entirely through even the very slow zone; and this can be done without resort to chromic treatment, the particular absorption rate desired being regulated wholly by the amount of ethylene oxide provided for reaction with the gut.

Sterility requirements The concentration of ethylene oxide necessary to achieve sterilization depends upon the size of the gut, total volume of the fluid, the number and kinds of organisms, the storage time, the storage temperature, etc. Fig. 2 reproduces the results of a very severe test designed to set the minimum ethylene oxide concentration neces- The test was made on the largest commonly used size gut, i. e. No. 4 gut. This large size gut was heavily contaminated with very resistant spore forms of Bacillus globigii. It was found by sealing the contaminated gut in a tube containing 1% by volume of ethylene oxide in 3 /2 cc. of ethanol tubing fluid, that sterility was achieved in three days. With reduction in ethylene oxide concentration, the period of time necessary to achieve sterilization gradually increased in accordance with the curve shown in Fig. 2, such that after the ethylene oxide concentration was reduced to .1% by volume, eighteen days were required to achieve sterility and that, when concentration was reduced to .05 ethylene oxide, approximately thirty days were necessary to achieve sterility. This concentration of .05% ethylene oxide is therefore considered to be the safe minimum standard for sterilization of all gauges and lengths of sutures utilized generally today, but, for smaller sizes, or storage periods exceeding 30 days, the concentration may be as low as .0l%. As a practical matter, sterilization in four days is highly desirable since it is necessary that sutures be completely sterile before they are marketed. Four-day sterility may be achieved in accordance with the following table, 60-inch lengths of gut being utilized in 3% cc. of 95 ethanol tubing fluid:

T m r flotiilcentfraon o Ethylene Gatgut Size srermty Fluid by DH Volume, y Percent Inclusion of softening agent In the examples of this invention, I prefer that the suture material be plasticized with water because'that plasticizer is inexpensive, easy to use and eflicient. minimum amount of water appears to be. necessary in order to accomplish sterilization by means of ethylene oxide. Theonly exception to this appears to be the fact that methyl alcohol may be substituted for water with comparable results. Where other fluids are used as tubing fluids, the minimum amount of water recommended for each 100 milligrams of suture varies with the tubing fluid used. in accordance with the following table:

TABLE II Mgms. Fluid Water/1C0 Mgs. Gut

Methanol Ethanol 2. 2-propanol 0 l-butanol 5g 2-methyl l-propanol 50 2 methyl Z-propano 50 Xylene 12. 5

In any event, with only the. minimum. amount. of water necessary to achieve sterility with ethylene oxide in any fluid, a very non-pliable suture. results. Usually, therefore, additional water to obtain optimum plasticity, e. g. to the extent of about 5% with ethyl alcohol and -15% with other alcohols, should be present.

Eflect on absorption rates of ethylene oxide concentration The limitation of the concentration of ethylene oxide to. only that small volume which is necessary to insure safe sterilization will result in the production of sterile catgut sutures which have very slow rates of absorption in animal tissue, substantially as slow as the absorption rate of raw oatgut. The effect on absorption rate of addition of further quantities of ethylene oxide up to the maximum 2% volume concentration limit of this invention will now be discussed. I First, it is necessary to set forth an acceptable method for determining absorption rates:

In the past, it hasbeen common practice to measure theabsorbability of catgut sutures either by measuring the rate of digestion of implanted sutures in experimental animals or the in-vitro rate of digestion in enzyme solutions; Both techniques provide valuable data, but both also have serious drawbacks; Animal work is technically diificult, takes long periods of time, and, in general, is subject to considerable-error. Enzyme techniques, on the other hand, although simpler-and less time consuming than animal studies, utilize preparations which are relatively impure and require careful standardization and control.

For thesereasons, I prefer a technique not so well known as the other two, but one which permits a much more precise measurement of absorption characteristics. This method, which is known as the shrinkage temperature method, has been described in detail in Surgery, Gynecology and Obstetrics, October 1946, volume 83, pages 5218-5271 Its use in evaluating absorption is predicated upon the: fact that it provides a precise measurementof the physical and chemical conditions of the collagen suture which are intimately involved in tissue digestion. The method depends for its utility upon the physical circumstance that catguts of similar origin and which have been subjected to similar treatment have a definite sharp temperature point at which shrinkage occurs when they are immersed. under slight tension in a gradually heated, bulfered aqueous solution. Suturesof the same size which have relatively high shrinkage temperatures have relatively slow rates of absorption Whereas sutures of the same size having relativelylow shrinkage temperatures are relatively very quickly digestible provided the treatment is of the same kind varying only as to intensity and duration.

The shrinkage temperature of raw gut is approximately 62 C. This raw gut shrinkage temperature varies somewhat depending. upon the technique used in its measurement,.upon the condition of the animal from which the catgut was obtained, and upon the initial processing from intestine to raw gut. At any rate, raw gut is relatively resistant to digestion.

When, however, raw gut is subjected to heat-sterilization (i 50 l60 C.) it is found that its shrinkage temperature has dropped by approximately 19"" C. Moreover, eventhough catgut is subjected to commercial chromic nseaunent', whereby its unsteri-lized shrinkage temperature rises to approximately -81 C., as distinguished from the 62 C. of plain gut, the. chromic gut, upon heat-stcrilization at 160 C., will also exhibit aloss in shrinkage temperature of about 19 C. I designate such a loss in shrinkage temperature, due to treatment, as the ten-rperatnre-absorbency decrement, sometimes referred to hereinafter as A. Temperature-absorbency decrements of the magnitude of about 19 C. for heat-sterilized gut indicate a substantial increase in rate of absorption of sterile gut in animal tissue over unsterilized gut. Inany process involving heat-sterilization, the decrement is always of this order of magnitude. While excessive tanning might tend to limit the decrement to a slightly lesser value, the inclusion of any metal such as chromium into sutures in high proportions grossly alters the chemical nature of the collagen and hence is undesirable.

In accordance with my invention, which omits heatsterilization and relies instead on chemical sterilization by ethylene oxide, I can produce sterile sutures which have temperature absorbency decrements ranging from practically 0 C; all the way up to a value corresponding tothat which is a maximum desirable rate of absorption in living tissue merely by regulating the amount of ethylene oxide added to the package.

In Fig. 3, I have indicated. the results of experiments with #1 plain catgut in sealed tubes with 3.5 cc. of tubing, fluid. showing the magnitude of loss in shrinkage temperature with time and increasing amounts of ethylene oxide. In Fig. 4, I have shown similar results in the case of chromic No. 1 catgut sutures. As shown in both Figs. 3 and 4, after substantial equilibrium has been reached (20' weeks storage), the temperature-absorbency decrement for a No. 1 suture, both chromic. and plain, is. between L0 and 12 C., with 1% ethylene oxide volume concentration.

Similar data has been assembled with respect to all other normal sizes of plain and chromic catgut, the results of which are reflected in Figs. and 6.

In Fig. 5 there is shown a series of curves which show the amount of ethylene oxide in 3.5 cc. of tubing fiuid causing ditferent temperature-absorbency decrements for each of the most popular sizes of U. S. P. gauge plain catguts now in use, the ethylene oxide concentration being plotted logarithmically.

Fig. 6 shows a similar relationship in the case of chromic gut.

In the case of both plain and chromic guts, I have determined that a temperature-absorbency decrement of about 13 C. is the maximum permissible decrement without increasing the rate of absorption beyond that which is commercially practical and acceptable to the surgeon. Thus, in both of the graphs shown in Figs. 5 and 6, any hermetically sealed package containing a weight of gut and a concentration of ethylene oxide such that is represented by any point to the left of the curves A13 will provide, after storage, a sterile catgut suture having satisfactory absorption characteristics; whereas those packages represented by points to the right of the curves A13 will provide sutures having impracticable fast absorption characteristics.

A table illustrating these principles in which average values of shrinkage temperature and A usually observed are presented, follows:

The effectiveness of temperature-absorbency decrement values as an accurate indication of absorption rate by enzyme digestion is shown in the graphs of Figs. 7 and 8.

Fig. 7 shows the loss in breaking strength in pounds with increasing time of enzyme digestion, each curve representing a No. 1 plain catgut of different temperatureabsorbency decrement caused by reaction with varying amounts of ethylene oxide. As there shown, as the temperature-absorbency decrement increases from a value of 0, which represents the control, to a value of 11, the rate of enzyme digestion as represented by the decrease in breaking strength, also increases. This is also shown, as illustrated in Fig. 8, wherein the increase in digestion rate, represented by a percent loss in weight of the suture, varies with the increase of temperature-absorption decrement.

The other experimental method of determining digestion, that is, by means of animal digestion studies involving implantation of catgut in animal tissue, also may be utilized to illustrate the relation of increased temperaturevabsorption decrement to increased absorption rate in the TABLE IV Percent of Original Strength After 14 Days Animal Implantation Temperature Absorbeney Decrement #1 Plain Gut Turning again to Fig. 1, the approximate positions of the A values for plain ethylene oxide reacted gut are indicated. Any plain ethylene oxide reacted gut which has a A value of approximately 9 or less provides a sterile gut which has a rate of absorption lower than any presently available to the surgeon. Furthermore, if the A value is kept below approximately 13 by proper proportioning of the ethylene oxide, one may provide untanned sterile catguts having, for the first time, absorption rates slower than the slowest absorption rate of present-day heat-sterilized plain catgut. If slow absorption rate is not essential, one may, in accordance with my invention, by the inclusion of greater amounts of ethylene oxide still within the 2% maximum limit, produce plain ethylene oxide reacted guts which approximate and even exceed absorption rates of present-day plain heat-sterilized catgut but whose processing and preparation is much more economical.

From my experiments with the sterilization of catgut by means of ethylene oxide in closed tubes, I have evolved formulae which give the approximate relationship after 6 months aging, between the weight of the suture, the percentage of ethylene oxide employed and the temperature-absorbency decrement. In the formulae, W represents the weight of a 60-inch length of catgut in milligrams, C represents the concentration by volume (i. e. 2% is represented by 2.) of ethylene oxide in 3 /2 cc. of tubing fluid and A represents the temperature-absorbency decrement brought about by the use of varying percentages of ethylene oxide with various weights of sutures. By the use of these formulae and by choosing values for two of the unknowns it is possible to determine the third unknown. Concentrations at other volumes may be obtained by the well-known equality CV=C1V1 where C represents the concentration of liquid ethylene oxide at any one volume V; and C1 represents a different concentration at a different volume V1.

For plain gut:

For chromic gut:

W= (77.5A-I-447) log C'74.3A+ 1158 Since the maximum A value is fixed at approximately 13 C., by the practically usable limit for absorbability the only other limitation appears to be the lower limit for general sterilization of .05 of ethylene oxide (.0l% of ethylene oxide for very small guts) for a thirty day sterilization period. Practically speaking, of course, there is a limit on the size of sutures. Catguts larger than size #4 are rarely used because smaller sutures give all the strength required, are much easier to use and do much less damage to the tissue being sutured.

Satisfactory examples of pliable U. S. P. sutures with acceptable absorption rates in accordance with this invention, tubed in ethanol with various amounts of ethylene oxide are contained in the following table:

a i-zxnproxi Tubing Fluid-3.5 cc. A ntfil e 1:17 ethyleneoxide.

9319 ethanol (95%)- A7 0.8% ethylene oxide. A7 99.2%"ethanl' (95%) I 0.8% ethylene oxide.

99.4% ethanol (95%). 0. 4%ethylene oxide- A7 99.6% ethanol (95%) 1 {0.3% ethylene oxide"..- A7 99.7% ethanol sa%) 0.2% ethylene oxide. 9.18%.ethanol (95%) y 0.2% ethyleneox'ide. A7 i ii ti i iii e yenep e. smo atmeal 95% A7 {0.1%ethylene oxide- 7 9.9% ethanol (95%)..." A {0.06% ethylene oxide- A7 99-9 %eth y {1.1% ethylene oxide..." 98.9%-ethanol'(95%) 1-'.0% ethylene oxlde. 9 .-Q% ethanol (9 Y j {0.7%ethylene oxide- A7 1 99.9% ethanol'(95%) 0.5% ethylene oxide. 7 t i wer l t 1, e yeneoin e.-.

#0 Chibmifl {g l 7% gl l q 5'? A7 e y ene 0x1 e..... #90 OhlOlniO. A7

, e yeneox e m. lihl'omicl gfl i A7 e yeneox e chromlc. gami g 51% A7 Y .2 e yeneox e chrome {99,8 %ethano1 1 5%)..- I A7 0.1% ethylene oxide- A3 99.9% ethanol (95%) 1 0.2%; ethylene oxide A5 99.8% ethanol (95%) 0.7% ethylene oxide A10 A13 l A3 A5 .1310 s Satisfactotytcxamples of U. S. P. sutures with acceptable absorption fates less than A13 in accordance this invention and tubed inw-ariousfluidsrare .containedin the following table, Examples 29, 35, 38 and 39 having less than-optimumlpliabilityz I i TABLE VI Example Catgut Size Tubing Fluid-3.5 cc.

0. 5% ethylene oxide. 28 #1 mam {09. 5% methanol.

1. 0% ethylene oxide. 29 #4 plain 1. 0% methanol.

98. 0% isopropanol.

1. 0% ethylene oxide. #3 chromic 9. 0% methanol.

90. 0% xylene.

0. 5% ethylene oxide. 31 #1 chromic 9. 5% methanol.

90. 0% xylene.

0.1% ethylene oxide. #0 plain 9. 9% methanol.

90. 8g, ngultanol. d 2. e yene oxi e. #4 61mm 98.0% ethanol (95%).

0. 02% ethylene oxide. 99. 98% ethanol (95%). 0. 5% ethylene oxide. 3. 0% methanol. 96. 5% xylene.

0. 5% ethylene oxide. 9. 5% water. 90. 0% isopropanol.

0. 5% ethylene oxide. 9. 5% water. 90. 0% acetone.

0. 5% ethylene oxide. 4. 0% water. 95. 5% diethyl carbonate.

0. 5% ethylene oxide. 5. 0% water. 94. 5% l-methoxy-Z propane]. 0. 1% ethylene oxide.

99. 9% methanol.

. 10 nxatnsples ofsutures "having unacceptably fast absotb ency ratesareasfoflows:

TABLE VII .Gatgnt Size ;Tubing Fluid3.5 cc. gafig ml (9 L- 20. 5.0% ethylene oxide. 95.0% ethanol (95%) #1 chromio }Greeter than 30.

' fect upon absorption rate does not appear to be as great as that "caused byethyle'ne oxide treatment. Hence, *sutures having absorption rates Within the acceptable limit for surgical use of thisinvention can be prepared by a combination-of low heat treatment and ethylene oxide treatment. Where-this isthe case the summation of the A values caused by each, may yield a total A value of slightly more't-han 1-3. In a case of combination of preheat .t'r'catmen-t and ethylene oxide treatment, the maximum allowable A value can therefor be 3-4 more than 13 (i. o. .up to about 17) and practical absorption-rates willstiIl be-maintained.

In preparing the sutures, the ethylene oxide is preferably introduced :into-the tube in a liquid condition before sealing. In order .to :do this, the ethylene oxide which is normally ages, is chilled below 10 .C. and preferably to 4 'C. Such liquid ethylene oxide may thereafter "he added in the proper proportion to the tubing fluid, which need not "be chilled, in any quantity. The aliquots for each package may then be measured oft from the prepared'mixtur'e.

Throughout the description hereinbefore given, and in all'the"testsjhereinabove referred to, the amount of .tubing fluid present inthe package was approximately 3 /2 cc., because that is .the volume of .tubing 'fluid generally observed in present day commercial suture put-ups, which are hermetically sealed packages and comprise flamesealed glass ampou1es,.-heretofore referred to as tubes.

Changes in volumekof the tubing fluid in any single package may require slight changes in ethylene oxide concentration based upon the total volume of the tubing fluid, in order to achieve equivalent results, particularly with respect to absorbability. The change in concentration should be downward with increasing volumes and, hence, in each case the amount by volume will always still fall within the range of about .01 to something less than 2%. In other words, increases in total volume of tubing fluid require reduction in the amount of ethylene oxide by volume in the tubing fluid in order to produce equivalent A value. Decreasing the total volume may require slight increase in concentration but never above about 2% by volume.

I claim:

1. A catgut suture conforming to minimum U. S. P. tensile strength suture requirements, said suture comprising a sterile reaction product of a strand of catgut with a solution containing ethylene oxide, the ethylene oxide being .01 to 2% by liquid volume ofythe solution, said reacted catgut having a shrinkage temperature of at least 49 C.

3. An interiorly sterile sealed container containing a tubing fluid and a flexible sterile catgut suture conforming to minimum U. S. P. tensile strength suture requirements, said suture comprising a sterile reaction product. of a strand of catgut with a solution containing ethylene oxide, the ethylene oxide being .01 to 2% by liquid volume of the solution, said reacted catgut having a shrinkage temperature of at least 49 C.

4. An interiorly sterile sealed container containing a tubing fluid and a flexible sterile catgut suture conforming to minimum U. S. P. tensile strength suture requirements, said suture comprising a sterile reaction product of a strand of catgut with a solution containing ethylene oxide, the ethylene oxide being .01 to 2% by liquid volume of the solution, said reacted catgut having a shrinkage temperature not more than 13 C. below that of the unreacted catgut.

5. A container in accordance with claim 4 wherein the tubing fluid comprises ethyl alcohol and water.

6. A container in accordance with claim 4 wherein the catgut is a 60-inch length of No. catgut suture, the ethylene oxide in the solution is in the range of about .2% and the reacted catgut has a shrinkage temperature of about 57 C, below that of the unreacted cutgut.

7. A container in accordance with claim 4 wherein the catgut, prior to reaction, is plain cutgut, and the initial percent concentration by liquid volume of the ethylene oxide, the initial weight of the suture, and the temperature absorbency decrement after substantial equilibrium bearing a relationship on the basis of 3 cc. of liquid solution as expressed substantially by the formula:

where A is a temperature absorbency decrement less than 13, W is the weight of the catgut in milligrams and C is the percent concentration by liquid volume of the ethylene oxide.

8. A container in accordance with claim 4 wherein the catgut, prior to reaction, has been chromicized, and the initial percent concentration by liquid volume of the ethylene oxide, the initial weight of the suture, and the temperature absorbency decrement after substantial equilibrium bearing a relationship on the basis of 3 cc. of liquid solution as expressed substantially by the formula:

where A is a temperature absorbency decrement less than 13, W is the weight of the catgut in milligrams and C is the percent concentration by liquid volume of the ethylene oxide.

9. The method of treating a catgut suture to sterilize the suture and impart to the same a predetermined rate of absorption in living animal tissue, comprising storing a catgut suture with a tubing fluid, hermetically sealed in a container, said tubing fluid comprising a liquid vehicle, ethylene oxide and a softening agent for catgut, said softening agent being selected from the group consisting of water and methyl alcohol, the amount of tubing fluid present containing softening agent in an amount suffi-. cient to render said catgut flexible while maintaining minimum U. S. P. tensile strength suture requirements, said ethylene oxide being present in a concentration by liquid volume of the tubing fluid of between .01 and 2%, and suflicient to sterilize said suture during said storage while maintaining U. S. P. tensile strength suture requirements, and the exact concentration of ethylene oxide within said .01 to 2% range being selected with relation to the weight of the catgut such that the predetermined rate of its absorption in living tissue is obtained while maintaining its shrinkage temperature during said storage within 13 C. of its shrinkage temperature prior to storage in said container.

10. The method as claimed in claim 9 wherein the shrinkage temperature of the catgut is maintained within 9 C. of its shrinkage temperature prior to storage.

11. The method of claim 9 wherein the suture is a inch length of No. 0 catgut suture and the ethylene oxide concentration is about .2% by volume of the tubing fluid and wherein the shrinkage temperature is maintained within 57 C. less than its shrinkage temperature prior to storage.

References Cited in the file of this patent UNITED STATES PATENTS 1,596,785 Weyland Aug. 17, 1926 1,970,578 Schoeller Aug. 21, 1934 2,075,845 Gross Apr. 6, 1937 2,189,947 Gnflith Feb. 13, 1940 2,215,453 Buchgraber Sept. 24, 1940 OTHER REFERENCES American Journal of Hygiene, vol. 50, pages 270-279, 1949. 

